Esophageal Manometry: Post-procedure Update

Ugh!

That’s the only thing I can say that isn’t exactly “not a nice thing” to say. There’s no way to say how today has gone without sounding like a whiner, so watch for yourself what I endured this morning, and then I’ll explain what the test showed (preliminarily by watching the screen) and how the rest of my day has gone.

Okayyyy? Now I can start my narrative.

We fought horrible traffic all the way in to the center. Since we both work from home, it’s been over a year since we’ve hit rush-hour traffic. We thought we were perturbed enough yesterday coming home at 3:30pm, but that was a far cry from this morning. Good grief, how do you people live like that? /wink Anyhoo, we didn’t have much more than a 15 minute wait before I was called back by a nice lady of about 50 named Betsy.

I advised her of my history of blowing chunks every time I had an NG tube placed. She ensured that I hadn’t had anything to eat or drink since midnight and listened to all of my concerns. I could tell she’d heard these concerns before, but she assured me that she’d been doing this a good many years and that it was pretty unlikely from my history that I would ruin her scrubs.

“We’ll see,” I said.

“Yes, we’ll see,” she said.

She filled a 5cc syringe with a clear gel and squeezed it into my right sinus (I told her which one was anatomically straighter) and had me snort. She did it again. I promise, that was awful, but the fun was just beginning. Then she squirted some on the back of my tongue to roll down to my throat. My tongue wouldn’t let it slide without swallowing it all too quickly. My tongue was going numb. She was taken a bit by surprise by that (so I’m thinking I’m in a smaller percentile group of patients now) and mixed in some water and had me gargle for 15 seconds. Satisfied, she gave me a minute to set up my phone to video the procedure and away we went with what you saw.

Next, she explained that she was going to give me some water from another syringe (just a sip from a 60cc deal) and I was to swallow once and only once until I was given another sip. Therein lies the rub: you would think this would be a very easy thing to do, and it is! It is, that is, until you have a tube the size of a laptop charging cable running from your nose to your stomach.

For several tries, I couldn’t avoid a sneak swallow before the next sip. She’d have to wait until that swallow action rippled all the way down to my stomach before giving me more. Every time I swallowed, we had to wait. After about 3 successful swallows over 10 tries, I got into a rhythm and went about 7 for the next 11 tries. She had to get 10 clean swallows before proceeding. I didn’t have all good swallows, either. Some were strong at the top and then a little blip at the bottom. Some needed two swallows. She showed me the difference (below). The one in the top image – the dip of red on the left is a “clean swallow” but it wasn’t a “good swallow.” That image shows 3 clean swallows, and even the last one on that screen wasn’t all that good, according to her and according to the ones in the second image.

Clear as mud? I think so. Anyway, I’ll get a more in-depth story about the images and data from the doctors next week. In fact, my doctors are so awesome, one of them is e-mailing me right now to tell me that we’ll have the results next week. My CF team rocks beyond belief!

So, then for the really hard part: hold a calm esophageal status for 20 seconds. No swallowing at all! I kid you not, it took upwards of 10 minutes to get a clear 20 seconds. I’d go 5 seconds, sometimes 12 seconds, and then I absolutely could not hold of the swallow reflex. If someone had a gun to my head and told me to not swallow for 20 seconds, I’d be dead… several dozen times over. After well over 30 swallows, tips, positioning, and encouragement, Betsy finally turned away to do something else and just said, “it’s up to you now.” About a minute later, I went as long as I could, swallowed, and she declared that one was long enough. I could stop stopping from swallowing.

Fifteen seconds later, the tube was out of my nose and she had the 24-hour tube ready. That one went in much easier because of its size, but she noted that I have such a strong upper esophageal sphincter that dry swallowing helped get the tube down better then drinking. She showed me how to use the monitor and we went home.

I’ve done my stand-up best to eat and work like normal, but I’ve almost had 2 complete freak-outs because when I swallow, the tip of my nose twitches from the tube being taped there and my sinuses get rubbed by the tube. It’s very irritating and distracting.

I’ve more or less got myself accustomed to the tube in my throat except when eating (which surprised me, as that was what I remembered most from my teens) when swallowing darn near jerks the tube – tape and all – into my nose.

I haven’t had any heartburn issues until I coughed after dinner. I got straight stomach acid all the way up, which burned, but it wasn’t the slow burn of yesterday. Maybe it’s just taking time to build up from an empty stomach this morning. I’m sure a good night’s sleep laying down will give them a good idea of what goes on. I woke myself up 4 or 5 times last night, coughing molten lava almost all the way up. That’s when I should have had the probe!

Well, it’s 8pm, so it’s time to watch American Idol. Have a good night, y’all.